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General NPI Number Information
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NPI Number | 1215727672
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Entity Type | Organization
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Legal Business Name | JIREH LIVING SUPPORTIVE HOUSING INC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1365 NORTH AVE APT 6B
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City | ELIZABETH
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State | NJ
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Zip | 07208-2658
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Country | US
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Telephone | 908-344-8369
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 NORTH AVE APT 6B
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City | ELIZABETH
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State | NJ
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Zip | 07208-2658
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Country | US
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Telephone | 908-344-8369
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | EMMANUELLA BOAKYE
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Credential |
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Telephone | 908-344-8368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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